Onkofertilite ve Radyasyon
Özet
Kanser tanı ve tedavisindeki gelişmeler her yaş grubunda sağkalım oranlarını artırırken, genç hastalarda tedavi sonrası çocuk sahibi olma arzusu "onkofertilite" kavramını doğurmuştur. Multidisipliner bir alan olan onkofertilite; kemoterapi, radyoterapi ve cerrahi gibi üreme sağlığına kalıcı zarar verebilecek gonadotoksik tedaviler öncesinde doğurganlığın korunmasını amaçlar. Kemoterapi over rezervini azaltıp folikül kaybına neden olurken, pelvik radyoterapi prematür overyan yetmezlik, uterus hasarı ve obstetrik komplikasyon risklerini beraberinde getirir. Kadın hastalar için başlıca fertilite koruma yöntemleri arasında embriyo, oosit ve ovaryan doku kriyoprezervasyonu, oosit in vitro matürasyonu, GnRH analoğu kullanımı ile radyoterapi alanını değiştiren ovaryan transpozisyon ve gonad koruyucu kalkan kullanımı yer almaktadır. Bu yöntemlerin seçimi hastanın yaşına, pubertal durumuna, partner varlığına, sahip olduğu kanserin türüne ve tedavinin aciliyetine göre bireyselleştirilir. Özellikle jinekolojik maligniteleri (serviks, endometrium ve over kanseri) olan reprodüktif dönemdeki hastalarda, sağkalımı etkilemeyecek durumlarda konizasyon, radikal trakelektomi ve unilateral ooferektomi gibi fertilite koruyucu cerrahi seçenekleri de başarıyla uygulanabilmektedir. Ayrıca DNA onarım bozukluğu nedeniyle over rezervi daha hızlı tükenen BRCA mutasyonu taşıyıcılarında da bu yaklaşımlar kritik öneme sahiptir. Başarılı bir onkofertilite süreci için hastaların tanı anında üreme uzmanları ve onkologlar tarafından hızla bilgilendirilmesi şarttır.
Advances in cancer diagnosis and treatment have significantly increased survival rates across all age groups, leading to the emergence of "oncofertility" to address the desire for future parenthood in young patients. As a multidisciplinary field, oncofertility aims to preserve reproductive potential prior to gonadotoxic treatments such as chemotherapy, radiotherapy, and surgery, which can permanently impair fertility. While chemotherapy accelerates ovarian reserve depletion and induces follicle loss, pelvic radiotherapy carries severe risks of premature ovarian failure, uterine vascular damage, and adverse obstetric outcomes. Key fertility preservation strategies for female patients include embryo, oocyte, and ovarian tissue cryopreservation, oocyte in vitro maturation, the use of GnRH analogs, and radiation-mitigating techniques like ovarian transposition or gonadal shielding. The selection of these methods must be individualized based on the patient's age, pubertal status, presence of a partner, cancer type, and the urgency of oncological treatment. In reproductive-aged patients with gynecological malignancies (cervical, endometrial, and ovarian cancers), fertility-sparing surgeries such as conization, radical trachelectomy, and unilateral oophorectomy can be successfully performed without compromising overall survival. Furthermore, these approaches are critical for BRCA mutation carriers, whose ovarian reserves deplete faster due to DNA repair deficiencies. Prompt counseling by reproductive endocrinologists and oncologists immediately after cancer diagnosis is essential for successful oncofertility outcomes.
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